title: Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty.
abstract: OBJECTIVE
  Outcomes of endovascular lower extremity interventions (eLEIs) have been recently linked to provider specialty; however, the indication for intervention was not examined. We sought to compare outcomes between specialties performing eLEI for different indications, in a recent statewide inpatient discharge dataset.
  
  
  METHODS
  The Florida hospital discharge data from 2005 to 2009 were reviewed for patients with LEI during hospitalization. We assigned provider specialty as interventional radiology (IR), interventional cardiology (IC), or vascular surgery (VS) based on provider-associated procedures. Clinical indication was claudication or critical limb ischemia (CLI). We limited our analysis to patients without concomitant open surgery during hospitalization. We compared mortality, length of stay (LOS), major use of intensive care unit (ICU), discharge disposition, and total charges between specialties with regression models, both unadjusted and adjusted for demographic and clinical characteristics.
  
  
  RESULTS
  A total of 15,398 patients (47% with CLI) had an eLEI. Clinical indication was significantly associated with provider type (P < .001) and outcomes. VS and IR were more likely than IC to treat CLI patients (VS 59%, IR 65%, IC 26%; P < .001). IC performed the majority of procedures on claudicants (VS 30%, IC 57%, IR 13%; P < .001), while VS performed the majority of procedures on CLI patients (VS 50%, IC 23%, IR 27%; P < .001). Adjusted analyses demonstrated no difference in mortality rates between the three specialties (odds ratio [OR] VS: reference, IR: 1.24, IC: 0.79; P = NS for both). However, compared with VS, IR-treated patients were less likely to be discharged home (OR, 0.74; P < .001), LOS was longer (β, 1.16 days; P < .001), major ICU use was more common (OR, 1.49; P < .001), and total charges were higher (β, $341; P = .001). CLI predicted poorer results for all outcomes: death (OR, 4.19; P < .001), discharge home (OR, 0.50; P < .001), increased LOS (β, 3.26 days; P < .001), major ICU use (OR, 1.95; P < .001), and total charges (β, $18,730; P < .001).
  
  
  CONCLUSIONS
  The majority of eLEI done by VS are for CLI, whereas the majority of patients treated by IC are claudicants. Although provider specialty does correlate with several clinical results, the clinical indication for eLEI is a stronger predictor of adverse outcomes. Future analyses of eLEI should adjust for clinical indication.
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: wallacejr@upmc.edu.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Wallace
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Theodore
authors.initials: T
authors.lastname: Yuo
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Luke
authors.initials: L
authors.lastname: Marone
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Makaroun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003422:Critical Care; D016638:Critical Illness; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D015641:Radiography, Interventional; D015642:Radiology, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures